Chapter 1
Copyright © 2018 Wolters Kluwer · All Rights Reserved Chapter 1 Decision Making, Problem Solving,
Critical Thinking, and Clinical Reasoning: Requisites for Successful Leadership and Management
Copyright © 2018 Wolters Kluwer · All Rights Reserved Decision Making, Problem Solving, Critical
Thinking, and Clinical Reasoning • Decision making: complex, cognitive process of choosing a particular
course of action; the thought process of selecting a logical choice from available options • Problem
solving: part of decision making; systematic process focusing on analyzing a difficult situation Copyright
© 2018 Wolters Kluwer · All Rights Reserved Decision Making, Problem Solving, Critical Thinking, and
Clinical Reasoning—(cont.) • Critical thinking or reflective thinking: the mental process of actively and
skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an
answer or conclusion Copyright © 2018 Wolters Kluwer · All Rights Reserved Characteristics of a Critical
Thinker • Insight • Intuition • Empathy • Willingness to take action Copyright © 2018 Wolters Kluwer ·
All Rights Reserved Clinical Reasoning • Integrating and applying different types of knowledge to weigh
evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis •
Collaborative and reflective process that involves content-specific knowledge, engagement of the
patient and family in understanding the clinical problem, and incorporation of critical contextual factors
• Leads to deliberative decision making and sound clinical judgement Copyright © 2018 Wolters Kluwer ·
All Rights Reserved Vicarious Learning to Enhance Decision-Making Skills • Case studies: provide stories
that impart learning • Simulations: provide opportunities for learning with no risk to patients or
organizational performance • Problem-based learning (PBL): provides opportunities for learners to
address and learn from authentic problems vicariously Copyright © 2018 Wolters Kluwer · All Rights
Reserved Experiential Learning • Provides mock life experiences to learn from • Allows learners to apply
leadership and management theory • Promotes whole-brain thinking and improved problem-solving
skills Copyright © 2018 Wolters Kluwer · All Rights Reserved Successful Decision Makers • Self-aware •
Courageous • Sensitive • Energetic • Creative Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question Which is a characteristic of a successful decision maker? A. Impulsiveness B. Courage C.
Decisiveness D. Whimsy Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. Courage
Rationale: A successful decision maker should be willing to take risks. Copyright © 2018 Wolters Kluwer ·
All Rights Reserved Marquis-Huston Critical Thinking Teaching Model Copyright © 2018 Wolters Kluwer ·
All Rights Reserved Problem-Solving versus Decision-Making Models The Traditional Problem- Solving
Process • Identify the problem. • Gather data to identify the causes and consequences of the problem. •
Explore alternative solutions. • Evaluate each alternative • Select appropriate solution • Implement
solution • Evaluate results. Managerial DecisionMaking Model • Determine the decision and the desired
outcome (set objectives). • Research and identify options. • Compare and contrast these options and
their consequences. • Make a decision. • Implement an action plan. • Evaluate results. Copyright ©
2018 Wolters Kluwer · All Rights Reserved Critical Elements in Problem Solving and Decision Making •
State a clear objective. • Gather data carefully. • Take the time necessary. • Use an evidence-based
approach. • Generate many alternatives. • Think logically. • Choose and act decisively. Copyright ©
2018 Wolters Kluwer · All Rights Reserved Nursing Process: A Problem-Solving and Decision-Making
Model • Assess. • Diagnose. • Plan. • Implement. • Evaluate. Copyright © 2018 Wolters Kluwer · All
Rights Reserved Feedback Mechanism of the Nursing Process Copyright © 2018 Wolters Kluwer · All
Rights Reserved Question Which is NOT a factor in solving a problem successfully? A. Using an evidencebased approach B. Doing all work independently C. Stating a clear objective D. Watching for faulty logic
Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. Doing all work independently
Rationale: It is important to use group process in some way to increase solutions. Copyright © 2018
Wolters Kluwer · All Rights Reserved Questions Asked in Data Gathering • What is the setting? • What is
the problem? • Where is it a problem? • When is it a problem? • Who is affected by the problem? •
What is happening? • Why is it happening? What are the causes of the problem? Can I prioritize the
causes? • What are the basic underlying issues? Areas of conflict? • What are the consequences of the
problem? Which of these are most serious? Copyright © 2018 Wolters Kluwer · All Rights Reserved
Questions Asked in Analyzing Solutions • What factors can you influence? How can you accentuate the
positive factors and minimize the negative factors? • What are the financial, political, time, and resource
implications of each possible solution? • What are the weighting factors? • What is the best solution? •
What are the means of evaluation? • What are the consequences of each alternative? Copyright © 2018
Wolters Kluwer · All Rights Reserved Question What is the first step in managerial decision-making
model? A. Identify the problem. B. Evaluate alternatives. C. Gather data. D. Set objectives. Copyright ©
2018 Wolters Kluwer · All Rights Reserved Answer D. Set objectives. Rationale: Although the traditional
model begins with identifying the problem, in managerial decisionmaking model, one approaches the
issue by first deciding on the objectives. Copyright © 2018 Wolters Kluwer · All Rights Reserved
Strategies for New Nurses to Promote Evidence-Based Practice • Keep abreast of the evidence. • Use
multiple sources of evidence. • Use evidence to support clinical interventions and teaching strategies. •
Find established sources of evidence. • Implement and evaluate nationally sanctioned clinical practice
guidelines. • Question and challenge nursing traditions. Copyright © 2018 Wolters Kluwer · All Rights
Reserved Strategies for New Nurses to Promote Evidence-Based Practice—(cont.) • Dispel myths and
traditions not supported by evidence. • Collaborate with other nurses locally and globally. • Interact
with other disciplines to bring nursing evidence to the table. Copyright © 2018 Wolters Kluwer · All
Rights Reserved Question Tell whether the following statement is true or false: New nurses should
question and challenge nursing traditions. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights
Reserved Answer A. True Rationale: New nurses should question and challenge nursing traditions and
promote a spirit of risk taking in order to best utilize evidence-based practice. Copyright © 2018 Wolters
Kluwer · All Rights Reserved Successful Decision Maker • Understands: – Gender – Personal individual
values – Life experience – Preferences – Willingness to take risks – Brain hemisphere dominance –
Predominant thinking style Copyright © 2018 Wolters Kluwer · All Rights Reserved Decision-Making
Tools • Decision grids • Payoff tables • Decision trees • Consequence tables • Logic models • Program
evaluation and review technique Copyright © 2018 Wolters Kluwer · All Rights Reserved Example of a
Decision Tree Copyright © 2018 Wolters Kluwer · All Rights Reserved Economic Man versus
Administrative Man
Chapter 2
Copyright © 2018 Wolters Kluwer · All Rights Reserved Chapter 2 Classical Views of Leadership and
Management Copyright © 2018 Wolters Kluwer · All Rights Reserved Leadership versus Management •
Leaders – Empower others; maximize workforce effectiveness – Needed to implement the planned
change that is part of system improvement • Managers – Guide, direct, and motivate others – Intervene
when goals are threatened – Emphasize control Copyright © 2018 Wolters Kluwer · All Rights Reserved
Managers and Leaders Leaders • Often do not have delegated authority but obtain their power through
other means • Have a wider variety of roles than managers and may have different personal goals • Are
frequently not part of the formal organization • Focus on group process, information gathering,
feedback, and empowering others Managers • Are always assigned a position within an organization •
Have a legitimate source of power due to the delegated authority that accompanies their position • Are
expected to carry out specific functions • Emphasize control, decision making, decision analysis, and
results Copyright © 2018 Wolters Kluwer · All Rights Reserved 1. A lack of energy and enthusiasm 2.
Acceptance of their own mediocre performance 3. Lack of a clear vision and direction 4. Having poor
judgment 5. Not collaborating 6. Not walking the talk 7. Resisting new ideas 8. Not learning from
mistakes 9. A lack of interpersonal skills 10. Failing to develop others Ten Fatal Leadership Flaws
Copyright © 2018 Wolters Kluwer · All Rights Reserved Characteristics of Managers • Have an assigned
position within the formal organization • Have a legitimate source of power due to the delegated
authority that accompanies their position • Are expected to carry out specific functions, duties, and
responsibilities • Emphasize control, decision making, decision analysis, and results • Manipulate
people, the environment, money, time, and other resources to achieve organizational goals • Have a
greater formal responsibility and accountability for rationality and control than leaders • Direct willing
and unwilling subordinates Copyright © 2018 Wolters Kluwer · All Rights Reserved Good Leaders and
Managers Good Leaders • Envision the future • Communicate their visions • Motivate followers • Lead
the way • Influence others to accomplish goals • Inspire confidence • Take risks • Empower followers •
Master change Good Managers • Coordinate resources • Optimize resource use • Meet organizational
goals and objectives • Follow rules • Plan, organize, control, and direct • Use reward and punishment
effectively to achieve organizational goals Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question What aspect of business should managers emphasize? A. Decision making B. Analysis C.
Results D. Control E. All of the above Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer E.
All of the above Rationale: Control, decision making, analysis, and results are all crucial elements of
successful management. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Which is a
characteristic of a leader? A. Always assigned a position of authority B. Usually part of a formal
organization C. Focus on group process, information gathering, and feedback D. Focus on decision
making and results Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer C. Focus on group
process, information gathering, and feedback Rationale: Although managers are more often part of a
formal organization and focus more on resultoriented tasks, leaders tend to focus more on things such
as group process. Copyright © 2018 Wolters Kluwer · All Rights Reserved Frederick W. Taylor (1911)
Scientific Management • Four principles – Traditional “rule of thumb” – Scientific personnel system –
Workers “fit” into the organization – Relationship between managers and workers is cooperative and
interdependent. Copyright © 2018 Wolters Kluwer · All Rights Reserved Henri Fayol (1925) Management
Functions • Planning • Organization • Command • Coordination • Control Copyright © 2018 Wolters
Kluwer · All Rights Reserved The Management Process Copyright © 2018 Wolters Kluwer · All Rights
Reserved Planning Encompasses determining philosophy, goals, objectives, policies, procedures, and
rules; carrying out long- and short-range projections; determining a fiscal course of action; and
managing planned change Copyright © 2018 Wolters Kluwer · All Rights Reserved Organizing • Includes
establishing the structure to carry out plans, determining the most appropriate type of patient care
delivery, and grouping activities to meet unit goals • Other functions involve working within the
structure of the organization and understanding and using power and authority appropriately. Copyright
© 2018 Wolters Kluwer · All Rights Reserved Staffing Consists of recruiting, interviewing, hiring, and
orienting staff; scheduling, staff development, employee socialization, and team building are also often
included as staffing functions Copyright © 2018 Wolters Kluwer · All Rights Reserved Directing Usually
entails human resource management responsibilities, such as motivating, managing conflict, delegating,
communicating, and facilitating collaboration Copyright © 2018 Wolters Kluwer · All Rights Reserved
Controlling Includes performance appraisals, fiscal accountability, quality control, legal and ethical
control, and professional and collegial control Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question Tell whether the statement is true or false: Team building is an aspect of staffing. A. True B.
False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. True Rationale: Although
recruiting, interviewing, and hiring are the tasks most often associated with staffing, team building is
also an important aspect of the job. Copyright © 2018 Wolters Kluwer · All Rights Reserved Luther Gulick
(1937) Seven Activities of Management POSDCORB – Planning – Organizing – Staffing – Directing –
Coordinating – Reporting – Budgeting Copyright © 2018 Wolters Kluwer · All Rights Reserved The
Human Relations Era • Participatory management • Humanistic management • Emphasizes people
rather than machines – Produced the “Hawthorne effect” Copyright © 2018 Wolters Kluwer · All Rights
Reserved Leadership • Leadership is the art of getting work done through others willingly. • Leaders are
in the front, moving forward, taking risks, and challenging the status quo. • A job title alone does not
make a person a leader. Only a person’s behavior determines if he or she occupies a leadership position.
Copyright © 2018 Wolters Kluwer · All Rights Reserved Leadership Roles • Decision maker •
Communicator • Evaluator • Facilitator • Risk taker • Energizer • Mentor • Critical thinker • Buffer •
Advocate • Coach • Counselor • Teacher • Forecaster • Visionary • Influencer • Creative problem solver
• Change agent • Diplomat • Role model Copyright © 2018 Wolters Kluwer · All Rights Reserved The
Evolution of Leadership Theories • Great Man theory/trait theories • Behavioral theories – Authoritarian
leader – Democratic leader – Laissez-faire leader • Situational and contingency leadership theories •
Interactional leadership theories • Transactional and transformational leadership • Full-range leadership
theories Copyright © 2018 Wolters Kluwer · All Rights Reserved Kouzes and Posner’s Five Practices for
Exemplary Leadership • Modeling the way: requires value clarification and selfawareness so that
behavior is congruent with values • Inspiring a shared vision: entails visioning that inspires followers to
want to participate in goal attainment • Challenging the process: identifying opportunities and taking
action • Enabling others to act: fostering collaboration, trust, and the sharing of power • Encouraging
the heart: recognize, appreciate, and celebrate followers and the achievement of shared goals Copyright
© 2018 Wolters Kluwer · All Rights Reserved Transactional Leader • Focuses on management tasks • Is a
caretaker • Uses trade-offs to meet goals • Does not identify shared values • Examines causes • Uses
contingency reward Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the
following statement is true or false: A characteristic of leadership management is to use trade-offs to
meet goals. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. True
Rationale: Trade-offs can be a useful tool to achieve goals. Copyright © 2018 Wolters Kluwer · All Rights
Reserved Transformational Leader • Identifies common values • Is committed • Inspires others with
vision • Has long-term vision • Looks at effects • Empowers others Copyright © 2018 Wolters Kluwer ·
All Rights Reserved Integrated Leader/Managers (Gardner, 1990) • Think longer term • Look outward,
toward the larger organization • Influence others beyond their own group • Emphasize vision, values,
and motivation • Are politically astute • Think in terms of change and renewal
Chapter 3
Copyright © 2018 Wolters Kluwer · All Rights Reserved Chapter 3 Twenty-First Century Thinking About
Leadership and Management Copyright © 2018 Wolters Kluwer · All Rights Reserved • Please show
Leadership Video Case: Leadership Succession and Creating a Motivating Climate, available as part of
Lippincott CoursePoint for Marquis and Huston: Leadership Roles and Management Functions in
Nursing, 9th edition. • For more info, visit thePoint.lww.com/CPMarquis9e. Copyright © 2018 Wolters
Kluwer · All Rights Reserved Factors Affecting Health-Care Trends • Growing elderly population • Healthcare reform • Reductions in reimbursements • New quality imperatives • Shift in focus of care to
community settings • Technological advances • Shift to customer-focused care Copyright © 2018
Wolters Kluwer · All Rights Reserved Qualities of a Nurse-Manager • Knowledgeable and skilled in
nursing practices • Competent in all aspects of management • Excellent communicator • Effective team
builder • Proactive in preparing for emerging new threats Copyright © 2018 Wolters Kluwer · All Rights
Reserved Focus of Recent Leadership and Management Concepts • Organizational context • Levels of
analysis • Potential boundary conditions on transformational leadership • Interactional leadership
Copyright © 2018 Wolters Kluwer · All Rights Reserved Leader-Manager’s Repertoire for the 21st
Century • Strength-based leadership • Level 5 leadership • Servant leadership • Principal agent
leadership • Human and social capital theory • Emotional intelligence and authentic leadership •
Quantum and thought leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Strength-Based
Leadership • Focuses on the development or empowerment of worker’s strengths • Activities include: –
Paying attention to multiple points of view – Searching for common ground – Prioritizing continuous
learning in the workplace – Promoting collaborative relationships (Wong) Copyright © 2018 Wolters
Kluwer · All Rights Reserved Strength-Based Nursing Leadership • Works with the whole while
appreciating the interrelationships among its parts • Recognizes the uniqueness of staff, nurse-leaders,
and the organization • Creates work environments that promote nurses’ health and facilitate their
development • Understands the significance of subjective reality and created meaning • Values selfdetermination • Recognizes that person and environment are integral and that nurses function best in
environments where there is a “goodness of fit" that capitalizes on their strengths Copyright © 2018
Wolters Kluwer · All Rights Reserved Strength-Based Nursing Leadership—(cont.) • Creates
environments that promote learning and recognizes the importance of readiness and timing • Invests in
collaborative partnerships Copyright © 2018 Wolters Kluwer · All Rights Reserved Jim Collins’s Level 5
Leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Jim Collins’s Level 5 Leadership—
(cont.) Copyright © 2018 Wolters Kluwer · All Rights Reserved Focus of Greenleaf’s Servant Leadership •
Putting others including employees, customers, and the community as the number one priority •
Fostering a service inclination in others that promotes collaboration, teamwork, and collective activism
Copyright © 2018 Wolters Kluwer · All Rights Reserved Principal Agent Theory • Suggests that not all
followers (agents) are inherently motivated to act in the best interest of the leader or employer
(principal) • Followers may have an informational (expertise or knowledge) advantage over the leader as
well as their own preferences, which may deviate from the principal’s preferences. • Principals must
identify and provide agents with appropriate incentives to act in the organization’s best interest.
Copyright © 2018 Wolters Kluwer · All Rights Reserved Human and Social Capital Theory • Human
capital represents the capability of the individual. • Social capital represents what a group can
accomplish together. Copyright © 2018 Wolters Kluwer · All Rights Reserved Emotional Intelligence •
Emotional intelligence refers to the ability to use emotions effectively and is required by
leaders/managers in order to enhance their success. • Emotional intelligence is critical for building a
cooperative and effective team. Copyright © 2018 Wolters Kluwer · All Rights Reserved Five
Components of Emotional Intelligence • Self-awareness • Self-regulation • Motivation • Empathy •
Social skills Source: Goleman (1998) Copyright © 2018 Wolters Kluwer · All Rights Reserved Which of the
following is a component of emotional intelligence? A. Self-reliance B. Assertiveness C. Self-regulation D.
Charisma Question Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer C. Self-regulation
Rationale: The five components of emotional intelligence are self-awareness, self-regulation,
motivation, empathy, and social skills. Self-reliance, assertiveness, and charisma are not components of
emotional intelligence. Copyright © 2018 Wolters Kluwer · All Rights Reserved Authentic Leadership •
Suggests that in order to lead, leaders must be true to themselves and their values and act accordingly •
Avolio et al. (2009) suggest that there are four factors that cover the components of authentic
leadership: balanced processing, internalized moral perspective, relational transparency, and selfawareness. Copyright © 2018 Wolters Kluwer · All Rights Reserved Five Distinguishing Characteristics of
the Authentic Leader Copyright © 2018 Wolters Kluwer · All Rights Reserved Five Distinguishing
Characteristics of the Authentic Leader—(cont.) Copyright © 2018 Wolters Kluwer · All Rights Reserved
Thought Leadership • Thought leadership applies to a person who is recognized among peers for
innovative ideas and who demonstrates the confidence to promote these ideas. • Thought leaders
attract followers not by any promise of representation or empowerment but by their risk taking and
vision in terms of being innovative. • Ideas put forth by thought leaders are future-oriented and
generally problem-oriented. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell
whether the following statement is true or false: Thought leaders attract followers by the promise of
representation or empowerment. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights
Reserved Answer B. False Rationale: Thought leaders attract followers by their risk taking and vision in
terms of being innovative. Copyright © 2018 Wolters Kluwer · All Rights Reserved Reflective Thinking
and Practice • Nurse-managers need to continually adapt, reflect on progress and setbacks, and adjust
their course. • Consider what one knows • Believe and value current situation • Reframe to develop
future responses and actions Copyright © 2018 Wolters Kluwer · All Rights Reserved • States that
leaders must work together with subordinates to identify common goals, exploit opportunities, and
empower staff to make decisions for organizational productivity to occur • Suggests that the
environment and context in which people work is complex and dynamic and that this has a direct impact
on organizational productivity Quantum Leadership Copyright © 2018 Wolters Kluwer · All Rights
Reserved Comparing Industrial and Relationship Age Leadership
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